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Watchful waiting may not be suitable for black men with low-risk prostate cancer

CTCA
July 12, 2013

A study conducted by The Johns Hopkins Hospital revealed that an “active surveillance” approach may not be a good idea for black men with slow-growing or low-risk prostate cancer.

Typically, men with very low-risk prostate cancer are thought to be good candidates for active surveillance, in which doctors delay treatment and closely monitor the cancer. This allows men to avoid the potential side effects of treatments like surgery and radiation, such as incontinence and impotence.

The new study included a sample of black and white men who were diagnosed with very-low-risk prostate cancer, all of whom had their prostates surgically removed soon after they were diagnosed. Researchers analyzed the prostates to determine whether there were any differences in the characteristics of the disease between the men of each race.

The findings, published in the Journal of Clinical Oncology, revealed that about 27 percent of black men had worse cancers than doctors originally thought, compared to about 14 percent of white men. Researchers also found more black men had cancers that were likely to return after they were removed.

Additional research published in The Journal of Urology found that black men are more likely to have more aggressive cancer that is not easily detected by current diagnostic methods.

"We think we are following a small, nonaggressive cancer, but in reality this study highlights that in black men, these tumors are sometimes more aggressive than previously thought. It turns out that black men have a much higher chance of having a more aggressive tumor developing in a location that is not easily sampled by a standard prostate biopsy,” said Dr. Edward Schaeffer, urologist and co-author of the study.

While active surveillance was previously considered safe in low-risk prostate cancer cases, the guidelines for it have, historically, been based on studies that included mostly white men.

The Hopkins study calls into question how these surveillance guidelines are determined; and highlights the opportunity to approve their accuracy by ensuring future research includes more African Americans.